Faith Within The Fast

Some Muslims With Diabetes Risk Health To Fulfill Spiritual Needs During Ramadan.

November 13, 2004|By Ruth Morris Staff Writer

Just 25 minutes before sundown, Zenatul Feroze, a diabetic Muslim, began to tremble and wilt. She hadn't eaten all day in observance of Ramadan, a holy month of dawn-to-dusk fasting, and a quick finger prick confirmed her hunch: her blood sugar had shot down. Her cells were starving for glucose. Her body was in revolt.

Feroze didn't dial 911, or even reach for a piece of bread. She lay quietly on her bed.

"I prayed, and in my mind I said, `If I'm going to die, it's OK. If I die in the month of Ramadan, I know it's a blessed month.' I said, `I'm not going to break my fast.'"

Stories like Feroze's can be heard in doctors' offices and mosques across the country as Muslims head into the final Ramadan weekend. While some diabetic Muslims skip fasting -- religious scriptures say ailing worshippers are exempt -- many feel spiritually unfulfilled unless they try to comply. Others may continue to fast after their bodies have sent warning signs, taking their physicians and themselves to a dangerous intersection where Western medicine collides with spiritual devotion.

Feroze, of Lauderdale Lakes, made it to darkness, to tea and dates, followed by a full meal. But a few days later the episode repeated itself, so she imposed a solution. She stopped measuring her blood sugar all together.

"It's really frustrating. Patients come in, and it's like: `You want me to forgo my eternal soul for a little sugar control?'" said Dr. Amal Sawires, an internist of Egyptian descent who often finds herself appealing unsuccessfully to diabetic Muslim patients to break their fast at this time of year. When they refuse to follow her advice, she said, she turns to prescription guidelines for diabetics about to go into surgery, cutting back on their diabetes medicine to match food intake levels. But it often comes down to complicated guesswork on whether a patient will better tolerate low or high blood sugar levels.

"It's not First World medicine," she said. "My job as a doctor is to give people options and let them decide. But I go from that to thinking, `My God, what is this?'"

Diabetes is a disease affecting 18.2 million Americans in which the body doesn't produce or properly use insulin. Since insulin carries sugar to fuel cells, diabetics suffer from erratic blood sugar levels -- a condition that's exacerbated by fasting and feasting. Long-term health risks include blindness, heart disease, renal failure and nerve damage.

All the same, for some Muslim diabetics, religious duties outweigh health risks. Fasting during Ramadan is one of the five pillars of Muslim devotion, along with praying five times a day and making a pilgrimage to Mecca.

"It's not how you function, it's how you feel. It's better to be close to God," said Jaber Abu Kishk, a marketing consultant and diabetic living in West Kendall. Kishk has fasted every day of Ramadan, even though he sometimes feels dizzy and his legs sometimes ache. His remedy is to rub alcohol on his muscles, and to relax the tension from his body. He never informed his doctor he would be abstaining from eating during daylight hours, and he said he keeps healthy by eating lots of garlic and ginger.

Sitting in a sparse office, his blood testing kit atop a stack of papers, he said fasting was like "when the teacher gives you an `A.' It feels so good. It purifies your body and your mind and that makes God happy."

Religious leaders generally take the side of health professionals, advising followers to break fast if their health is failing. They point to scriptures that exempt nursing mothers, pregnant women, the ailing and the elderly from fasting, and they suggest donating food to the needy instead.

Islamic scholar Shafayat Mohamed of the Darul Uloom Institute in Pembroke Pines said worshippers should turn to their own conscience when deciding what to do. He said he often tells sick worshippers to "feel free" to eat during the day. But he added: "In most cases, faith overrides everything. When a doctor gives up, he says to pray."

Even physicians recognize that the decision to fast or not may be an agonizing one for many Muslim diabetics. The exercise is meant to draw worshippers into a more pious state, to dampen passions and focus the mind. It's also a shared undertaking. Muslims often break their fast at a mosque, gorging on curry, lamb, fruit and dates. When Feroze was diagnosed with diabetes she decided not to fast for two years running and she missed the experience.

"It made me feel unfulfilled," she said. "I felt lost."

Health providers also stressed that in many cases fasting can be managed, but only if diabetic patients consult frequently and frankly with their doctors.

"It's an issue for several religions that observe fasting," said Maria Gough, nurse manager at the Diabetes Care Center of South Miami Hospital, pointing to Orthodox Jews, for example, who fast during Yom Kippur. "They might need some adjustment to their medicine, or even to put their medication on hold. It depends on the person."

For Sawires, who works in East Boston and treats a largely Muslim, North African population, the balance hinges on patient compliance. Too often, she said, a diabetic Muslim will seek out her help, only to refuse her advice, namely to break their fast. If that same patient were to become gravely ill, she said, they would likely rush to the emergency room, entrusting their lives to Western medicine at the last minute.

"You want to be open-minded and you want to be sensitive to people's cultural understandings," she said. "But you also could say, `Choose a side.' People expect Western medicine to pick up the pieces."

Ruth Morris can be reached at rmorris@sun-sentinel.com or 954-356-4691.